FAQs

FAQs

For Patients

The ratings measure how doctors performed in providing particular recommended tests during 2014. The ratings are not intended to be an indication of overall doctor quality.

Particular health tests or procedures may be recommended by health care organizations for patients that meet certain criteria, such as patients in a particular age group or patients who have particular medical conditions, in order to improve health outcomes. The ratings on this site report the percentage of patients for which a doctor provided these recommended tests and procedures for certain patients.

The ratings for each doctor reflect two measures: first, how the doctor compares to other doctors in his or her specialty practice area in terms of providing the test/procedure for patients for whom it is recommended; and second, the percentage of the doctor’s patients for whom a test/procedure is recommended who actually received the test/procedure. The doctor’s page will also show a rating from one to four stars, which reflects where the doctor ranks on the first measure, compared to other physicians.

Each time a patient sees a doctor for a particular health problem, the doctor submits a bill for the service, or a claim, to the patient’s health insurance plan. The CHPI ratings reflect information from insurance claims. For example, the Breast Cancer Screening measure reflects the percentage of the doctor’s patients for whom the screening was recommended who actually received the screening, according to claims data. Insurance claims are not always complete or accurate, but most research suggests that claims data is appropriate for the limited set of measures that CHPI is reporting.

Ask your doctor about particular measures to make sure that you are receiving the recommended health tests and procedures that your doctor thinks are medically necessary for you. An open dialogue between you and your doctor will hopefully foster increased trust and communication to improve your overall health care.

Doctors were given the opportunity to review their CHPI data for inaccuracies, but few doctors took advantage of this opportunity. As CHPI is a new program, many doctors may not have learned about CHPI in time to review their data.

CHPI rates the doctor types for which there were nationally-endorsed measures that could be run using claims data and that focused on outpatient, ambulatory care. The following types of doctors appear in the ratings:

Family Practice, General Practice and Internal Medicine doctors, also known as “primary care physicians,” who provide comprehensive care to people of all ages.

Each type of doctor is eligible for particular measures. For example, Family Practice, General Practice, Internal Medicine and Obstetrics & Gynecology doctors are eligible for the Breast Cancer Screening measure. CHPI’s Physician Advisory Group determined which doctor types are eligible for which measures.

For Doctors

Almost all of the corrections that were submitted during the Review & Corrections period have been applied. The only corrections that were not applied were those for which the discrepancy reason was “Other” and the write-in response contained information that conflicted with the reporting rules or that suggested that the record had not been reviewed.

As a CMS Qualified Entity, we are obligated to report the ratings. The only instance in which we would suppress a rating would be if we have listed the incorrect specialty for you. If we have listed the incorrect specialty for you, please let us know using this form.

If we have listed the incorrect specialty or practice address for you, please let us know using this form. It is not possible to update this information in real-time, however we will update this information on a weekly basis.

We aim to conduct the Review & Corrections period for the measurement year 2015 results during the summer of 2017, and to report those ratings at the end of 2017. Over time, the lag between the measurement and reporting years will be reduced. If you would like to receive email updates, please provide us your contact information.

General

The California Healthcare Performance Information System (CHPI) is a 501(c)(4) nonprofit, public benefit corporation whose mission is to serve as a trusted source of healthcare data to measure the quality and affordability of care, reporting performance ratings to and educate the public about healthcare value, and drive improvements in healthcare in California. CHPI began operating in late 2012, and the Pacific Business Group on Health (PBGH) staffs CHPI’s operations through a management services agreement.

Blue Shield of California made an initial community grant to fund the launch of the new entity. In addition, all three of CHPI’s founding health plans, Anthem Blue Cross, Blue Shield of California and UnitedHealthcare of California, have invested significantly in the development of the program. Each participating health plan will continue to contribute to future reporting cycles.

CHPI’s Board of Directors has representation from health plans, purchasers, consumers and providers. Health plans and purchasers represent two-thirds of the Board seats and consumers and providers represent one-third. The committee structure includes members drawn from all stakeholder groups. The Physician Advisory Group serves as an advisory committee to the Board of Directors. A key role is to provide clinical review and guidance related to the design of the measurement and reporting program, selection of measures, attribution method, review of findings, and presentation of results.

As a Qualified Entity, CHPI is eligible to receive Medicare fee-for-service claims and enrollment datasets for California beneficiaries. These Medicare datasets have been combined with health plan data to create provider performance ratings. Per the Qualified Entity designation, these quality performance ratings must be reported to the public.

The CHPI measurement system utilizes a multi-payer claims and eligibility data aggregation process. CHPI maintains 3+ years of claims history. The datasets do not include allowed amounts or provider fee schedule information. In CHPI’s initial work, the focus is on quality and appropriateness of care performance.

CHPI aggregates claims and eligibility data from the commercial and Medicare HMO and PPO products of the three largest California health plans – Anthem Blue Cross, Blue Shield of California and UnitedHealthcare of California. Additionally, as a designated Medicare Qualified Entity, CHPI integrates Medicare data for California. CHPI has received Medicare fee-for-service claims representing over 3 million California beneficiaries, and has integrated these claims with its private health plan claims data. In all, CHPI aggregates administrative claims and eligibility data for approximately 10 million lives across California to create physician performance ratings. And, we welcome participation of other California data suppliers and will discuss with the State the opportunity to add Medi-Cal data.

Yes, data is available for purchase. Please email chpi@pbgh.org for a data request packet, which includes the application, data dictionary, and DUA. There are two datasets that are available.

The Performance Ratings were generated using the combined Commercial and Medicare fee-for-service data to produce provider and practice-level clinical quality ratings for approximately 10,000 physicians and 6,000 practices sites across the state.

The Aggregated, De-identified Claims Dataset contains commercial HMO, PPO, POS, and Medicare Advantage claims and encounters for 7 million members. This data is available in two datasets: 2010 – 2012 and 2013 – 2014. Due to CMS Qualified Entity regulations, Medicare fee-for-service data is only available to a limited set of authorized users at this time.